We interventional
cardiologists doing CAG and PCI frequently and during these procedures ionizing radiation is used
extensively. Radiation
in the cath lab is generated using two different modes: fluoroscopy or cine
angiography (cine). Actually we are having radiation hazard more frequently than others,
despite wearing such a heavy lead apron.
Modern
cardiac interventional procedures (CAG and PCI) produce effective doses of 4 to
21 mSv and 9 to 29 mSv respectively and are therefore relatively high (1 mSv is
the equivalent of approximately 10 chest x-rays)
Radiation
has a cumulative effect and leads to increased risk for many conditions, most
notably, cancer. Just recently, an Israeli research team that has been tracking the
incidence of head and neck tumors in interventional cardiologists and
radiologists has now amassed 36 reports of brain and neck malignancies among
physicians working with ionizing radiation in cath lab. The group has
identified a total of 36 cases, including 28 interventional cardiologists, two
electrophysiologists, and six interventional radiologists. Tumor types included
glioblastoma multiforme (50% of cases) astrocytomas (7%), and meningiomas
(14%).
We
should not forget that Roentgen died from radiation-induced cancer because he
did not know the devastating consequences of x-ray exposure. Even in this
modern era of technology, radiation safety practices are often ignored. We are
so enthusiastic to do cath procedures that we even do not care about ‘cracked
lead apron’. Moreover, my cath lab does not have the overhanging lead screen
that can prevent radiation exposure to brain. We should have dosimeters that should be
read monthly.
Another
risk we suffer is the chance of developing orthopedic injury from standing for
long periods of time wearing heavy lead aprons. In one study, more than 400
interventionalists were surveyed and 71% of the study population reported some
type of orthopedic disease. And it has been reported that the most common cause
of early retirement for interventional cardiologists is spinal injury.
At
least I am not going to attempt chronic total occlusion (CTO) intervention anymore.
1.
Roguin A. Radiation hazards to interventional cardiologists: A report on
increased brain tumors among physicians working in the cath lab. SOLACI 2014;
April 23, 2014; Buenos Aires, Argentina. (heartwire April 23, 2014)
2. Catheter Cardiovasc Interv.
2004;63:407-11
No comments:
Post a Comment